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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496801588
Report Date: 10/22/2021
Date Signed: 10/22/2021 10:47:04 AM

Document Has Been Signed on 10/22/2021 10:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:CHANATE CARE HOMEFACILITY NUMBER:
496801588
ADMINISTRATOR:CREDO, JOSEPHINEFACILITY TYPE:
740
ADDRESS:3615 CHANATE RD.TELEPHONE:
(707) 526-4153
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 5CENSUS: 5DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Licensee, Josephine CredoTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Victoria Willis arrived unannounced, to conduct an Annual Required inspection and were greeted by staff. Administrator, Josephine Credo arrived later. The inspection is focused on the Infection Control procedures and practices of this facility.

Upon arrival, LPA was screened by staff and screening was documented. LPA initiated walk-through of the facility with at 9:30am and observed COVID-19 posters throughout that included hand washing signs in restrooms. Facility was a comfortable temperature and exits were free from obstructions. Infection control has been discussed with residents and staff. Hand sanitizer is located throughout the facility including in resident's rooms. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected on each shift and after use of bathroom(s) and dining room.

Facility has a designated visitation area outside and is allowing for visitation in resident rooms. Per Licensee, she has read the most recent Provider Information Notice regarding visitation and is following that guidance. Staff have completed PPE training and have been N95 fit tested.

Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. Facility maintains a 30 day supply of medication.


Administrator and LPA discussed their Emergency Disaster Plan.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Willis
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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